Addiction treatment is unfortunately a hodge-podge of therapeutic interventions, collected together because of past experience and provider bias; we have very few evidence-based approaches to patient care. Many of us in the addiction treatment field would welcome research on what constitutes effective treatment. So why do we have so little scientific knowledge? The answer in a nutshell is money. Despite the pervasive nature of addiction and its untold effects on families and society at large, treatment effectiveness and outcome research is an infinitesimal portion of the national healthcare research budget.
So what to do? Many quality providers spend time reworking and rethinking the treatment process. We cannot abandon critical thinking with an empty hope that some day the national agenda will shift and policymakers realize that addiction effectiveness research is even mildly important.
We have been rethinking our approach to addiction treatment to increase our patients' understanding and acceptance that they have a progressive and potentially fatal malady. We have found that teaching about the disease of addiction is important, but teaching the skills of recovery is even more critical. Now don't get me wrong. I believe it is important for patients to conceptualize and accept the fact that addiction is a primary disease. It is especially important, by the way, for patients to eschew deeply held notions that they know what caused their addiction. For example: "It is a deep tragedy that you child developed a fatal disease, but it is incorrect that this is the cause of your subsequent addiction disorder." Life traumas, family conflict, etc. do contribute to the development of addiction. Contribute, yes. Cause, no.
Our recent work is focused on codifying a set of attitudes, beliefs and behaviors that will lead to recovery. The Big Book of A.A. has many pearls of wisdom scattered through out the text. We believe such pearls are sufficient to maintain recovery, but commonly insufficient in helping some one attain recovery in the first place. Thus, we are in the process of re-engineering our treatment program to provide meaningful areas of core recovery competence." By dividing these into categories or bins and by using specific exercises to build the "core competencies of recovery," treatment will focus less on where some one "is" and more on "where to go."